Provider Demographics
NPI:1083831069
Name:STEVENS, CAROLYN ELIZABETH (APN)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:ELIZABETH
Last Name:STEVENS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:MS
Other - First Name:BETH
Other - Middle Name:
Other - Last Name:STEVENS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APN
Mailing Address - Street 1:228 CABRIOLET ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:AR
Mailing Address - Zip Code:72364-2516
Mailing Address - Country:US
Mailing Address - Phone:901-485-4156
Mailing Address - Fax:
Practice Address - Street 1:901 N 7TH ST
Practice Address - Street 2:
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-2001
Practice Address - Country:US
Practice Address - Phone:870-735-4334
Practice Address - Fax:870-735-1393
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR31912163WC1500X
ARA01672 ANP363LF0000X
ARP00843363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics